Healthcare Provider Details

I. General information

NPI: 1053121251
Provider Name (Legal Business Name): MRS. LINA W. SAAKA-SEREBOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LINCOLN SQ
WORCESTER MA
01608-1135
US

IV. Provider business mailing address

10 LINCOLN SQ
WORCESTER MA
01608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 860-794-1899
  • Fax:
Mailing address:
  • Phone: 860-794-1899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: